SPECIAL NUTRITION

CHAPTER 18

SCENARIOS
LEARNING OBJECTIVES
1 | Identify and define special nutrition scenarios.

2 | Define common key terms related to common nutrition scenarios.

3 | Identify which scenarios are outside the scope of practice and

require a professional referral.

4 | Provide talking points to use when discussing special scenarios

with affected clients.

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BEYOND THE SCOPE OF PRACTICE

Local laws and governing bodies will determine the scope of practice for certified nutritionists.

Generally, a nutrition coach may not practice medical nutrition therapy pertaining to health

conditions such as diabetes, disordered eating, alcoholism, morbid obesity, and other serious or

chronic conditions. However, as part of an overall health care team, the nutrition coach should be

aware of the special nutrition scenarios they may encounter with clients, the nutritional effects of

these situations, and the various interventions used to treat chronic conditions.

DIABETES MANAGEMENT
The vast majority—over 75 percent—of adults with diabetes are overweight or obese.

Nutrition interventions have proven successful, yet many individuals don’t know that dietary

counseling is an option. One study found that only about 9 percent of adults diagnosed with

diabetes have seen a registered dietitian in the past nine years of their illness.

If a client reports being diagnosed with diabetes, a nutrition coach should encourage them to

schedule a visit with a registered dietitian for dietary suggestions. Many of the guidelines for

a diabetic individual will be similar to those for the general population, so a nutrition coach

would be fully prepared to work with them. However, a registered dietitian can provide advice

for specific considerations that the coach can then help the client implement.

Common Dietary Interventions

There is no single, scientifically backed dietary plan that works for everyone with diabetes.

The same general nutrition guidelines apply to a diabetic client as to a general client; overall

calorie intake, variety of foods, balance, and consistency remain the focus. Physical exercise

is always a beneficial addition to a healthy, maintainable lifestyle.

However, several eating patterns have been shown to be somewhat effective in managing

diabetes. These include the Mediterranean-style eating plan, the Dietary Approaches to Stop

Hypertension (DASH) eating plan, a plant-based diet, a lower-fat diet, and lower-carbohydrate

diets. There are many foods that do not affect blood glucose levels as much, and these are

known as low-glycemic foods. They are more slowly digested, absorbed, and metabolized and

therefore cause a slower blood glucose rise. Diabetic clients can focus on these low-glycemic

food options as well.

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Here are the goals of nutrition interventions for diabetes:

• Promote and support healthful eating patterns.

• Emphasize variety and nutrient density.

• Teach proper portion sizes.

• Achieve and maintain healthy bodyweight.

• Delay or prevent complications from diabetes.

Other elements of diabetes counseling include the following:

• Weekly self-weighing

• Daily breakfast to control blood sugar

• Reducing fast-food consumption

• Meal replacement foods or supplements to reduce calorie intake

These goals and elements are aimed at improving the client’s individual glycemic, blood

pressure, and blood lipid goals. Blood glucose levels are measured by an A1C test and
A1C:
reported as a percentage. For most adults, their A1C should be less than 7 percent. A healthy A type of hemoglobin,
commonly abbreviated as
blood pressure should be less than 120/80 millimeters of mercury. Finally, blood lipids
HbA1c, bound to glucose
should maintain the following levels: and commonly used as a
marker to reflect how well
type 1 and type 2 diabetes
• LDL <100 milligrams per deciliter (mg/dL) are controlled.

• Triglycerides <150 mg/dL

• HDL (men) >40 mg/dL

• HDL (women) >50 mg/dL

Blood glucose, lipids, blood pressure, weight, and renal function levels must be monitored on

a regular basis by a diabetic client’s physician.

DISORDERED EATING
DISORDERED EATING:
Disordered eating and eating disorders are very different conditions. Both involve an Unhealthy eating behaviors
and feelings about body
abnormal relationship with food, and only diagnosis by a qualified professional can image.
determine the difference. Any irregular eating behavior—binge eating, purging, starvation,

self-denial, obsession, and so on—is considered disordered eating. However, for someone EATING DISORDERS:
to be diagnosed with an eating disorder, their symptoms must fall into specific criteria as Abnormal or disturbed eating
habits (once diagnosed) such
determined by the American Psychiatric Association. as anorexia or binge eating..

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Common Types of Disordered Eating

Anorexia nervosa is an emotional eating disorder in which a person obsesses over losing

weight and restricts caloric intake in a dangerously extreme fashion. Only about half the

patients with this condition will make a full recovery with proper treatment.

Another common emotional eating disorder is bulimia nervosa. Individuals suffering from

bulimia often have a distorted body image and engage in extreme overeating (binging),

followed by depression and self-induced vomiting (purging) or fasting. With treatment, about

half of bulimia sufferers can recover.

Binge-eating disorder is considered a severe, life-threatening eating pattern in which the

individual regularly overconsumes calories. Unlike bulimia, binge eaters do not typically purge

after consumption, and the result of such high-calorie intake is weight gain. This is the most

common eating disorder, with about 2 percent of people worldwide being affected. It also has

the best treatment outcomes, with about 70 percent of patients recovering with the proper

guidance and support.

Other Disordered Eating Habits

• Orthorexia: The name originates from the word ortho, meaning “correctness.”
Orthorexia is an unhealthy preoccupation with “eating healthy“ or “eating

properly.” People with this condition will restrict based on ”good“ and “bad“

foods and may feel guilt or anxiety surrounding the “wrong“ foods.

• Cognitive dietary restraint: Someone who constantly is thinking about

food, dieting, or restricting may have cognitive dietary restraint. They may never

act on their feelings about food, but the mere thoughts have the power to create

a physical, stress, or hormonal response.

• Body dysmorphia: This is a mental disorder in which someone is extremely

preoccupied with flaws in their appearance, whether imagined or real. They may

think themselves imperfect or in need of changes, even if their body is healthy

and falls within “normal“ ranges for their age and height.

• Food addiction: When the need to eat or consume calories becomes

compulsive or unpredictable, this is food addiction. Someone with food addiction

no longer uses food as fuel for their body but as a response to emotion or stress

or as a coping mechanism. Long-term food addiction can disrupt the body’s

natural hunger signals and hormones, leading to eating despite being full and

seemingly uncontrollable and frequent food cravings.

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Signs and Symptoms
If a coach observes any of the following signs or symptoms in combination, a referral to a

registered dietitian might be in order.

Table 18.1 Symptoms and Signs of Eating Disorders

ANOREXIA NERVOSA BULIMIA NERVOSA

Dehydration Dehydration
Dizziness Fatigue
Fainting Dizziness
Fatigue Muscle cramps (caused
Low blood sugar by electrolyte imbalance)

Low body temperature Bad breath

Physical
Underweight or extreme Dental cavities
thinness Weight changes
Bruising Sore throat
Dry hair Use of the restroom
Headaches immediately after eating

Slow heart rate Stomachaches

Depression Compulsive behavior

Compulsive behavior Anxiety
Social isolation Guilt
Emotional
Uncomfortable around food Mood swings
Anxiety Depression
Poor self-esteem

Dos and Don’ts for a Nutrition Coach

A fitness and nutrition professional must listen to their clients. The physical signs of

disordered eating may exist in many clients, but the psychological and emotional symptoms

may be harder to notice. If a coach suspects a client of disordered eating, here are some

dos and don’ts.

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A coach should DO the following:

Listen to and hear what their client is saying about how they feel.

Have a network of medical professionals to whom they can refer clients.

Encourage clients to seek help as soon as possible.

Ensure that they are providing accurate information and recommendations

about nutritional guidelines and sustainable lifestyles.

Encourage positive self-image in their clients.

Be sensitive and discreet.

Comply with any treatment plans if their client is under the care of a medical or
psychological professional.

A coach should NOT DO any of the following:

Make derogatory remarks about a client’s weight or appearance

Focus on weight or measurements too frequently

Judge or criticize

Provide “simple” solutions (“All a person has to do is…”)

DID YOU KNOW?

A short five-question client survey can help a coach identify someone’s risk of disordered

eating. The SCOFF questionnaire asks the following questions:

1 Do you make yourself sick because you feel uncomfortably full?

2 Do you worry you have lost control over how much you eat?

3 Have you recently lost more than one stone (14 pounds) in a three-month period?

4 Do you believe yourself to be fat when others say you are too thin?

5 Would you say food dominates your life?

If a client answers yes to two or more of these questions, a coach should strongly consider

making a referral to a specialist.

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Outside of changes in weight, disordered eating carries many potentially adverse health

effects. Conditions like anemia, nutrient deficiencies, permanent electrolyte imbalance,

kidney issues, dry skin, chronic edema (swelling), and problems regulating body temperature

can occur. Many of these conditions cannot be remedied.

ALCOHOL-USE DISORDER
There are no globally recognized alcohol consumption recommendations, but the Center for

Disease Control and Prevention (CDC) recommends moderation, which they define as up to

one drink per day for women and up to two drinks per day for men. One drink is equal to 14

grams of alcohol or 12 ounces of beer, 8 ounces of malt liquor, or 5 ounces of wine.

Estimates suggest that more than 15 million people in the United States struggle with some

sort of alcohol-use (or, more the point, overuse) disorder.

Signs and Symptoms

Acute physical symptoms of alcohol use include slowed reaction time, blackout, trouble

with motor control, impaired judgement, increased risk-taking, memory impairment, memory

lapses, and slurred speech. Anyone showing these signs likely still has alcohol in their blood.

The chronic physical symptoms of prolonged and excessive alcohol consumption include

signs of malnutrition, restlessness, agitation, anxiety, muscle tremors, nausea and vomiting,

and cardiovascular disease.

Behavioral symptoms include frequent binge drinking, moodiness, declining work performance,

making excuses for neglecting responsibilities, acts of violence, decreased interest in

activities outside of drinking, and denial of excessive alcohol use.

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Interventions for Alcohol-Use Disorder

The first step in treating an alcohol-use disorder is the initial detoxification, or detox. The

detox period must be medically supervised so that withdrawal symptoms can be monitored

and treated. Inpatient rehabilitation may be necessary in many cases. This is the most

structured type of treatment and can last 30, 60, or 90 days. Around-the-clock care is given.

Following successful inpatient treatment, alcohol counseling and support is necessary. Clients

should meet with an alcohol counselor to address triggers—peers, family relationships, work,

or other circumstances. The counselor may also teach clients how to manage emotions, offer

health education, or both.

To find local services in the United States for clients with an alcohol-use disorder, a coach can

look to the Substance Abuse and Mental Health Services Administration. This government-

funded organization provides information resources and acts as a referral service.

Research has shown how nutrition can be used to reduce hypoglycemic symptoms, decrease

sugar and alcohol cravings, and increase nutrient intake during alcohol rehabilitation. When

working with a recovering client, a coach should adhere to any protocols and recommendations

provided by the client’s health professional.

MORBID OBESITY
A person who is morbidly obese has an excessive amount of bodyfat. They typically have a

body mass index (frequently written as BMI) of 35 or higher.

Signs and Symptoms

Clients who are morbidly obese typically experience a variety of health problems. Along with

coping with fatigue, joint pain, trouble walking, or trouble breathing, morbidly obese clients

are at a much greater risk of developing chronic diseases.

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Common Dietary Interventions
The most common intervention for treating morbid obesity is a very low-calorie diet (VLCD).

Calories are restricted to between 450 and 800 kilocalories per day. Clients selected for
this type of intervention often lose a significant amount of weight in just 8 to 16 weeks. Low-

calorie diets (LCDs) are a less drastic intervention for obesity management, involving a daily caloric
reduction of 25 to 30 percent. Registered dietitians make personalized recommendations for

LCDs based on the client’s energy requirements, the severity of obesity, and other diseases

for which the client is being treated.

Intermittent fasting may serve as an additional or complementary intervention. Recent trials

have shown how pairing LCDs with intermittent fasting improves body composition—

lowering fat mass—and metabolic parameters. The trial was successful for patients

with obesity, including those with type 2 diabetes.

HEALTH MANAGEMENT
The health conditions previously discussed are outside the scope of practice for a nutrition

coach because of the level of care, individual variability, management, and expertise

required. The following health conditions have been successfully treated with dietary

interventions. The methods for controlling or preventing hypertension, osteoporosis, and

heart disease are well researched and proven.

The nutrition coach may not practice medical nutritional therapy by creating personalized

meal plans. However, they may share the following recommendations.

HYPERTENSION
Blood pressure is the pressure of circulating blood on the walls of the blood vessels. It is

measured in terms of systolic and diastolic pressure. Systolic pressure (the top number

in a reading) is the pressure of blood as it leaves the heart while diastolic pressure is the

measure of blood in between heart beats. Normal blood pressure ranges between 90 and HYPERTENSION:
120 systolic and 60 and 80 for diastolic. Hypertension is a condition of abnormally high A condition of abnormally high
blood pressure, usually over
blood pressure, usually over 130/80. The CDC estimates that one in three adults over 130/80.

the age of 20 in the United States have hypertension or are prehypertensive.

Dietary Approaches to Stop Hypertension (DASH) is a flexible and balanced eating pattern

specifically addressing this common condition. For clients managing hypertension, the key

is the reduction of daily sodium intake.

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The DASH diet guidelines encourage individuals to eat the following foods:

• Vegetables • Poultry

• Fruits • Beans

• Whole grains • Nuts

• Fat-free or low-fat dairy • Vegetable oils

• Fish

Foods high in saturated or trans fats should be limited. Intake of added sugars (those found

in sugar-sweetened beverages and sweets) and alcohol should be reduced from the daily

maximum recommendation referred to earlier. Additional recommendations include choosing

foods rich in calcium, fiber, magnesium, potassium, and protein.

OSTEOPOROSIS
Human bones are at their densest around the age of 30. Cells within bones are constantly
Osteoporosis
A medical condition remodeling and repairing while regulating calcium in the body.
characterized by low bone
mass and deterioration of bone Osteoporosis is a bone condition in which bones become weak and brittle. Logic suggests
tissue, leading to increased
bone fragility and susceptibility that increasing the daily intake of bone-strengthening calcium would prevent osteoporosis.
to fractures.
However, data from the Food and Agriculture Organization / World Health Organization does

not support this. Women over 50 are the most susceptible to osteoporosis, and the condition
Osteopenia is four times more common in women than in men.
Osteopenia: A condition
characterized by lower-than-
normal bone density that is not The precursor to osteoporosis is osteopenia. This occurs when the body is unable to make
low enough to be classified as
osteoporosis. It indicates new bone as quickly as it absorbs or breaks down old bone. Osteopenia is common in the
reduced bone strength and an
increased risk of developing
United States and is caused in part by a low-calcium diet as well as by smoking, hormones,
osteoporosis. and some medications (similar to full osteoporosis).

The leading cause of osteoporosis is a lack of estrogen in women and androgen in men. A

sedentary lifestyle, thyroid conditions, smoking, some medicines, and nutrient deficiencies

also play a part in the development of osteoporosis.

DID YOU KNOW?

Physical exercise and strength training with weights put stress on the muscles and therefore

the bones. The result of consistent resistance training is the thickening of muscle tissue and

the increase in bone density. Keeping bones as strong as possible for as long as possible in

the life span can combat the natural bone loss people face as they age. This is one of the

many reasons seniors are encouraged to exercise and to work on flexibility.

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Physical exercise puts stress on bones, which promotes bone fortification and strength.

Diet is also important for taking in the required minerals and vitamins needed for bone

development and growth. The prevention of osteoporosis requires a consistent lifestyle of

exercise and sound nutrition. Clients with osteoporosis can prevent further damage and injury

by increasing their intake of calcium via dietary adjustments and supplements if needed.

Table 18.2 Dietary Sources of Nutrients for Osteoporosis

FOOD NUTRIENT

Dairy

Low-fat and nonfat milk, yogurt, and cheese Calcium

Fish

Canned sardines and salmon (with bones) Calcium

Fatty fish such as salmon, mackerel, tuna, and sardines Vitamin D

Fruits and vegetables

Collard greens, turnip greens, kale, okra, Chinese cabbage,

Calcium
dandelion greens, mustard greens, and broccoli

Spinach, beet greens, okra, tomato products, artichokes,

Magnesium
plantains, potatoes, sweet potatoes, collard greens, and raisins

Tomato products, raisins, potatoes, spinach, sweet potatoes,

Potassium
papaya, oranges, orange juice, bananas, plantains, and prunes

Red peppers, green peppers, oranges, grapefruits, broccoli,

Vitamin C
strawberries, brussels sprouts, papaya, and pineapple

Dark leafy greens such as kale, collard greens, spinach, mustard

Vitamin K
greens, turnip greens, and brussels sprouts

Fortified foods

Certain juices, breakfast foods, soy milk, rice milk, cereals,

Calcium and vitamin D
snacks, and breads

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HEART DISEASE
The phrase heart disease can describe any number of conditions affecting the blood vessels,

heart, and blood and is the number one cause of death in the United States. One of the

most common forms of heart disease is atherosclerosis, which is caused by the buildup of

cholesterol on the walls of arteries.

The best treatment for heart disease is prevention. The American Heart Association suggests

the following diet and lifestyle habits:

• People should aim to burn at least as many calories as they consume daily.

• Each week, people should get 150 minutes of moderate physical activity or 75

minutes of vigorous activity, or a combination of the two.

• People should eat a variety of foods from each of the food groups.

• People should eat fewer calorie-dense, nutrient-poor foods.

The DASH eating pattern, so helpful for hypertension, has also proven to be effective at

preventing heart disease and is an option for at-risk clients.

If a client has a heart condition, a coach should hold them accountable for regular visits with

their physician to monitor blood pressure and lipids. It’s important for a nutrition coach to not

prescribe a meal plan or to counsel clients on specific dietary needs.

DID YOU KNOW?

It is important for clients to take an active role in their health to prevent heart disease. The

more they understand their risks and current health, the better able they will be to prevent

heart disease. A coach should encourage their clients to ask questions.

Here are some questions clients can ask their doctors to better understand their heart

health and risks:

• What is my personal risk of heart disease?

• What is my blood pressure, and what does it mean?

• What are my cholesterol levels?

• Are there activities I need to avoid?

• What tests are you doing for my heart?

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LIFE SPAN CONSIDERATIONS
When considering the entire life span, a coach must consider the needs of young people from

infancy through the teenage years, the specific needs of women during pregnancy and while

nursing, and how nutritional needs change in late adulthood and senescence.

YOUTH
Nutritional habits and good health begin in infancy. Breastfeeding is considered the ideal

option to support optimal infant growth and development. Outcomes improve if breastfeeding

lasts for 12 months or longer. If new moms cannot breastfeed, as discussed later, there

are other options more readily available. Infant formulas are now available to provide the

necessary nutrients to growing babies.

Infants and young children can usually self-regulate calorie intake innately. They may eat very

small amounts at one meal and very large amounts at another. But at a young age, children

are eating for sustenance, not as a response to emotions. This is a learned behavior they

adopt as they age. Around six months of age, infants will typically begin to transition to solid

foods in addition to breastfeeding. Fresh, whole foods can be pureed or cooked for ease of

consumption and minimal chewing, as most babies begin to break teeth around the same

age. Premade baby food is readily available in stores, but some parents choose to prepare

fresh options at home. Infant taste buds develop slowly, but research does not support the

idea that babies should not have stronger-tasting foods. Parents can introduce new, solid

foods one at a time into the baby’s diet to see how they respond. The slow introduction of

new foods will prevent gastric upset and protect against as-yet-unidentified food allergies.

As children enter their early teens, they start puberty. The dramatic hormone shifts, growth spurts,

and brain changes occurring during puberty lead to an increased need for nutrients and calories

to support the growth. Females in puberty typically require around 2,000 calories daily while

pubescent males can require 2,500 to 3,000 calories daily. The focus should be on whole foods,

iron, zinc, vitamins, and fiber to support efficient growth and brain maturation.

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DID YOU KNOW?

Childhood obesity is officially an epidemic. Obesity in children is defined as a child being

overweight for their age and height. About 13.7 million children and teenagers are affected

in the United States today.

Youth nutrition programs aimed at educating children and their guardians on proper nutrition

and sustainable eating patterns are the key to successfully addressing and reversing this

epidemic. Children who make good food choices typically grow into adults who continue to

make good nutritional choices. The USDA’s MyPlate and its associated resources are great

tools to help children understand good food choices. These resources also provide useful

information for adults who purchase the foods they then feed to their children.

Hydration for youth should not be overlooked. Children are smaller than adults, and for

that reason, they can lose heat and water faster. Physicians typically recommend that youth

between the ages of 2 and 9 drink 40 to 64 ounces of water daily and that youth ages 10

to 13 drink 64 to 80 ounces of water daily. Adolescents over 15 should be consuming a

half gallon or more of water daily—the same intake as an adult. The recommendation for

youth athletes is about twice these amounts to account for water loss during activity from

perspiration and increased metabolism.

Malnutrition
When most people think of malnutrition, they think of starvation. It is much more than that.

And malnutrition—deficiency, excess, or imbalance in a person’s intake of energy and/or

nutrients—is just as common in the developed world as in third-world countries. There are

three types of malnutrition:

1 Undernutrition, including wasting (low weight for height), stunting (low height for age),

and underweight (low weight for age)

2 Micronutrient-related malnutrition, including micronutrient deficiency or excess

micronutrient intake

3 Overweight, obesity, and diet-related noncommunicable diseases, such as heart

disease, stroke, diabetes, and some cancers

Malnutrition can be prevented with proper macronutrient and micronutrient intake in the form of

a healthy diet. The following are suggested serving sizes for youth between the ages of 2 and 18.

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Table 18.3 General Dietary Guidelines by Age and Gender (Youth and Teens)

AGES 2 TO 3: DAILY GUIDELINES FOR MALES AND FEMALES

Calories* 1,000–1,400

Protein 2–4 ounces

Fruits 1–1.5 cups

Vegetables 1–1.5 cups

Grains 3–5 ounces

Dairy 2 cups

AGES 4 TO 8: DAILY AGES 4 TO 8: DAILY

GUIDELINES FOR GUIDELINES FOR
FEMALES MALES

Calories* 1,200–1,800 1,200–2,000

Protein 3–5 ounces 3–5.5 ounces

Fruits 1–1.5 cups 1–2 cups

Vegetables 1.5–2.5 cups 1.5–2.5 cups

Grains 4–6 ounces 4–6 ounces

Dairy 2.5 cups 2.5 cups

AGES 9 TO 13: DAILY AGES 9 TO 13: DAILY

GUIDELINES FOR GUIDELINES FOR
FEMALES MALES

Calories* 1,400–2,200 1,600–2,600

Protein 4–6 ounces 5–6.5 ounces

Fruits 1.5–2 cups 1.5–2 cups

Vegetables 1.5–3 cups 2–3.5 cups

Grains 5–7 ounces 5–9 ounces

Dairy 3 cups 3 cups

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Table 18.3 General Dietary Guidelines by Age and Gender (Youth and Teens)
(Continued)

AGES 14 TO 18: DAILY AGES 14 TO 18: DAILY

GUIDELINES FOR GUIDELINES FOR
FEMALES MALES

Calories* 1,800–2,400 2,000–3,200

Protein 5–6.5 ounces 5.5–7 ounces

Fruits 1.5–2 cups 2–2.5 cups

Vegetables 2.5–3 cups 2.5–4 cups

Grains 6–8 ounces 6–10 ounces

Dairy 3 cups 3 cups

Adapted from the Mayo Clinic. *Calories depend on growth and activity level.

Picky Eaters

Eating habits—whether healthy or not—are developed by age three. Therefore, this is a

sensitive period of development. It is important to help children establish healthy eating

habits for a lifetime of good nutrition. Here are some tips:

• Parents should be patient and consistently introduce healthy foods, even if

children consistently refuse them.
• Parents should not push foods without overall nutritional value just to meet
calorie needs.
• Parents should introduce a variety of colorful foods at each eating opportunity.
At breakfast, parents might offer foods from three or more of the five major food
groups. At the main meal, perhaps they could offer foods from four or more of the
major food groups.
• Parents should introduce different textures by varying cooking methods—raw
fruits and vegetables, cooked al dente, poached, steamed, mashed, boiled,
broiled, baked, and so on.
• Parents should not use calorie-dense, sugar-sweetened foods as a bribe to get
children to eat healthy food at mealtime.
• Parents should involve peer role models and show cautious children how other
children enjoy new foods.
• Parents can invite children to be part of the process by letting them help select
fresh foods in the grocery store and giving them age-appropriate chores in the
kitchen during meal preparations.

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PREGNANCY AND NURSING
Nutrition is an important part of pregnancy, as food not only fuels the mother but also helps

the fetus grow and develop. Clients will have questions about what they should take to

supplement their diet, support their fitness training, and keep their growing baby healthy.

Much of what women need to support a healthy pregnancy can be found in whole foods.

However, with severe nausea and reduced stomach capacity (as the fetus grows), eating a

balanced diet with a large variety of foods can be a challenge. Many physicians prescribe

prenatal vitamins and may refer women to a registered dietician to improve dietary intake.

Here is some general nutrition advice to support a healthy pregnancy.

Weight Gain
The physician should closely monitor a woman’s weight throughout her pregnancy. Depending

on the mother’s weight and physical condition prior to pregnancy, the average woman can expect

to gain between 10 and 35 pounds during gestation. The Institute of Medicine recommends

that a newly pregnant female not change her calorie intake during the first trimester. They

should add 300 to 350 additional daily calories during the second trimester and 400 to 450

additional daily calories during the third trimester to support a growing fetus. Anything more

will likely cause excess weight gain and potentially lead to health complications related to

excess bodyweight like gestational diabetes or high blood pressure. These conditions can be

dangerous for the mother and the baby.

Weight loss should not be a focus during pregnancy. If a client is losing weight during their

pregnancy, they should see their physician immediately.

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Nutrients
Pregnant women need vitamin D and calcium to help prevent preeclampsia. Inadequate

calcium levels can trigger this dangerous condition, which leads to high blood pressure.

And vitamin D is needed for proper absorption of calcium. Pregnant clients can get plenty of

vitamin D by being out in the sun for 20 to 30 minutes three to four times a week. Fortified

foods like milk, milk substitutes, almond milk, and cereals also provide vitamin D. Calcium

can be found in fortified foods, leafy green vegetables, legumes, nuts, seeds, figs, and tofu.

During pregnancy, women should consume about 1,000 milligrams of calcium per day and

600 international units (IU) of vitamin D.

There are other minerals crucial during pregnancy:

PREECLAMPSIA:
A pregnancy condition of high
blood pressure caused by • Zinc is important for cell division and protein synthesis. Women typically need
inadequate calcium, typically
beginning around 20 weeks. It twice as much iron during pregnancy (around 27 milligrams per day).
can cause organ damage and
be harmful to the growing fetus. • Iron is essential for making red blood cells and carrying blood to the fetus.

• Vitamin B12 helps promote cell development as well.

• Folate, also known as folic acid and vitamin B9, is an essential nutrient for

preventing birth defects. In particular, adequate folate helps to prevent neural

tube defects, those affecting the spinal cord and brain. The role folate takes in

preventing these defects is most critical during the first trimester of pregnancy.

• Protein is essential for the development of the fetus, and just over two pounds of protein

will be taken in by the baby throughout pregnancy. Women should eat 25 grams of

additional protein each day during the second and third trimesters of pregnancy.

• Iodine helps maintain normal thyroid function in expecting mothers. The thyroid is

important for body temperature control, metabolism, heart rate, and hormone regulation.

• Omega-3 fatty acids support development of the fetal brain and also decrease

the risk of postpartum depression.

Pregnant women should avoid consuming large quantities of fish because of the risk of

consuming heavy metals like mercury. Acceptable fish high in omega-3s include the following:

• Salmon

• Anchovies

• Herring

• Trout

• Sardines
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Alternative sources of omega-3s include ground flaxseeds, walnuts, hemp seeds, seaweed,

leafy green vegetables, algae, and canola oil. Pregnant women should limit the previously

listed fish, despite their being rich in omega-3 fatty acids, to six ounces or less per week.

DID YOU KNOW?

There are many things pregnant women should completely avoid. Here’s a list of some of

the most important:

• Tobacco products

• Alcohol

• Hair dyes and chemicals

• Cured meats and deli meats

• Soft cheeses

• More than 300 milligrams of caffeine per day

• Artificial sweeteners

• Raw eggs

• Raw seafood

Some types of fish should never be consumed during pregnancy: swordfish, king mackerel,

tilefish, and shark.

Breastfeeding
For new moms who choose to breastfeed, one concern they may have is whether restricting

calories and exercising will impact their milk supply. Studies have found that exercise “had

no adverse effect on the volume or composition of the breast milk, infant’s weight gain, or

maternal prolactin levels.” Experts report, though, that nursing mothers should eat between

400 to 500 additional calories per day to support breast milk production. These additional

calories should come from whole grains, protein, and lots of colorful fruits and vegetables. A

nutrition coach can help a postpartum mother calculate her calorie needs while taking these

factors into account.

Good hydration is important for everyone but especially for new mothers. Nursing mothers

should drink at least one cup of water at each feeding to prevent dehydration.

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Breast Milk Facts

Breast milk plays a very important nutritional role in the physical and mental development

of a baby.

• Breast milk is a living substance. It has live cells—stem cells—that proliferate

into other cell types such as the brain, heart, kidney, or bone tissue.

• Breast milk has antibodies and live white blood cells that protect the baby from infection.
The amount of antibodies in breast milk increases if the mother or baby gets sick.

• Colostrum—the first milk produced after the birth of a baby—has special proteins
that coat the inside of the baby’s intestinal tract to protect it from harmful bacteria.

• During breastfeeding, the mother’s brain releases the hormones prolactin and
oxytocin to help mother and baby bond.

• Mothers who breastfeed have a lower risk of developing breast cancer, ovarian
cancer, heart disease, stroke, type 2 diabetes, and postpartum depression.

• Breastfeeding lowers the risk of the baby developing common childhood illness

such as ear infections, respiratory infections, and gastroenteritis.

MENOPAUSE
Menopause is part of the natural aging process for females. Around age 50, the ovaries stop
MENOPAUSE:
The period in a woman’s life producing estrogens. The body still produces estrogen from fat cells and the adrenal glands,
(typically after the age of
50) when the ovaries cease but when the ovaries cease production, blood levels of estrogens drop dramatically.
the production of estrogen
and progesterone and
menstruation ends. Signs and Symptoms
Some women may not have any symptoms while others experience the full range, including

the following:

• Hot flashes / body temperature • Changes in body composition and

regulation issues fat distribution

• Depression • Changes in sleep efficiency or

• Irritability patterns

• Anxiety

Nutrition
Diet—specifically animal protein intake—may play a role in when menopause hits as well as

the severity of symptoms (hot flashes). Research suggests that the intake of animal products

has such a sufficiently great effect on hormones that it can affect the functioning of the body.

For women experiencing hot flashes, a low-fat, vegetarian diet is strongly recommended.

Regular physical activity—a brisk walk every day—also seems to alleviate hot flashes.

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Table 18.4 Dietary Recommendations in Menopause
GENERAL DIETARY RECOMMENDATIONS IN MENOPAUSE

Calcium Two to four servings of calcium-rich foods per day

Between ages 51–70, get at least 600 IU per

Vitamin D
day; over 70, get 800 IU daily

Iron At least three servings of iron-rich foods per day

Fiber Twenty-one grams per day

Fruits and At least 1.5 cups of fruit and two cups of

vegetables vegetables daily

Water Drink eight glasses of water daily

Fat should comprise no more than 25 to 35

Fat percent (or less) of total daily calories; saturated
fat should comprise 7 percent or less

Sugar and salt Reduce sugar and salt intake

Alcohol Limit alcohol

ANDROPAUSE
While women experience a sudden drop in hormone production with the onset of menopause,
andropause, sometimes called male menopause, happens gradually. Andropause may also
ANDROPAUSE:
Referred to as male
be called testosterone deficiency syndrome, androgen deficiency of the aging male, or late- menopause, it is a
syndrome associated with
onset male hypogonadism. Testosterone levels vary among men. However, hormone levels low levels of testosterone
in older and aging men.
decrease with age, so older men have less testosterone than younger men. The average
decline is about 1 percent per year after age 30.

Signs and Symptoms

Men going through andropause may experience any of the following:

• Reduced sexual desire (libido) • Reduced muscle mass and strength

• Erectile dysfunction • Decreased bone density

• Fewer spontaneous erections • Loss of body hair

• Infertility • Decreased motivation

• Insomnia or increased sleepiness • Depression

• Increased bodyfat • Trouble concentrating or with memory

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Nutrients
One common cause for andropause is zinc deficiency. Zinc is involved in almost every aspect

of male reproduction. Taking 30 to 45 milligrams of zinc per day with 2 to 3 milligrams of

copper has been shown to help.

OLD AGE
As age-related or lifestyle-related decline progresses, barriers to good nutrition increase and

present a special challenge to the certified nutritionist.

As people age, they become less active, their metabolism slows, and their energy and nutrient

needs decrease. Although they should eat less, many continue to consume similar amounts

of food as they used to when they were younger and more active.

Here are a few factors affecting dietary intake in aging people:

• Loss of appetite

• Changes in taste

• Reduced ability to smell

• Reduced ability to swallow

These factors can influence people in making poorer food choices and choosing overly sweet

or salty processed foods manufactured to feel, look, smell, and taste good in the mouth.

Older adults can also experience decreased mobility as they age. Grocery shopping, opening
cans or jars, and cooking become more difficult and may push them to choose faster, easier,

and often less healthy options—fast food, microwave meals, and so on. A fixed income after
retirement may also make it difficult for older adults to choose high-quality foods, as they can

be more expensive.

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Nutrients
Working within the individual constraints of each client, it is important for a nutrition coach to

advocate including the following nutrients.

Table 18.5 Nutrients and Foods for the Elderly

NUTRIENT FOOD CHOICES BENEFITS

Fortified cereals and fruit juices

Calcium and Dark-green leafy vegetables

Supports bone health
Vitamin D Canned fish with soft bones

Milk and fortified plant beverages

Supports bone health

Prevents anemia
Fortified cereals May reduce risk of macular
Vitamin B12 Lean meats degeneration

Some fish and seafood Promotes brain health

Increases energy

Supports heart health

Whole-grain breads and cereals Promotes regularity

Fiber Beans and peas Lowers risk of heart disease

Fresh fruits and vegetables Prevents type 2 diabetes

Fruits and vegetables

Potassium Lowers the risk of hypertension
Beans

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FOOD ALLERGIES AND HYPERSENSITIVITIES

There is a difference between a food allergy and a food intolerance. A food allergy occurs
FOOD ALLERGY:
when the body’s immune system responds to a food as if it is harmful and tries to destroy it.
An abnormal immune
response (such as vomiting, A food intolerance means the body has a difficult time digesting a food or ingredient in the
hives, or trouble breathing)
to a food. food—such as dyes, preservatives, or other added chemicals. In general, food intolerances

or allergies are considered hypersensitivities.

FOOD INTOLERANCE:
Digestive issues or distress SIGNS AND SYMPTOMS
after consuming a food or
ingredient.
With a food allergy, symptoms include rash, hives, trouble breathing, swelling, cough, and

watery eyes. With food intolerance, symptoms may include stomach trouble (gas, pain, or

bloating), diarrhea, headache, fatigue, or acid reflux.

DID YOU KNOW?

One of the most severe and fatal food allergies in the United States is shellfish allergy.

Shellfish include shrimp, lobster, and crab, and even the simple act of preparing these

items can cause a reaction to those affected.

If a client is concerned they might have a food hypersensitivity, they need to consult their physician.

ELIMINATION DIET: The physician can then perform allergy testing or prescribe an elimination diet - typically monitored
A physician- or dietitian-
by a registered dietitian—to determine which foods may be triggering symptoms.
prescribed eating plan in
which a client will gradually
remove foods from their Common Food Hypersensitivities
diet with the goal of
Depending on the individual, anything can be the cause of a food allergy or intolerance. There
determining what is causing
an allergy or intolerance. are many triggers not referenced here, so a coach should refer a concerned client to their

primary care physician or a registered dietitian for insight into any symptoms they may have.

1 Gluten
Gluten is a type of protein found in wheat, barley, and rye. It is common in many processed

foods as a binding agent. Clients can avoid gluten by eating fruits, vegetables, meat and

poultry, fish and seafood, dairy, beans, legumes, and nuts. Alternative grain and starch

options include amaranth, arrowroot, cassava, chia, corn, flax, gluten-free oats,

millet, nut flours, potato, quinoa, rice, sorghum, soy, tapioca, and yucca.

2 Soy
One of the most common allergies in children is soy, although many tend to grow

out of it. Soy, however, is one of the eight major allergens. Federal law requires food

manufacturers to list potential soy ingredients or contamination on any food sold in

the United States.

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 Soy can be found in baked goods, canned broths and soups, canned tuna and meat,

cereals, cookies, crackers, high-protein energy bars and snacks, infant formulas, low-

fat peanut butter, pet food, processed meats, sauces, soaps, and moisturizers.

3 Lactose
Nearly 65 percent of the world’s population has trouble digesting lactose.

Lactose is a natural sugar found in milk, cheese, and other dairy products.

4 Shellfish
Certain proteins found in marine creatures trigger reactivity in the human body.

Clams, crabs, lobster, oysters, scallops, and shrimp are included in this food group.

5 FODMAP
FODMAP is an acronym for fermentable oligosaccharides, disaccharides,

monosaccharides, and polyols. This is a group of carbohydrates that draws water

into the intestine during digestion. Many individuals—around 86 percent—with

irritable bowel syndrome react to high-FODMAP foods.

Table 18.6 FODMAP Ratings of Common Foods

HIGH FODMAP LOW FODMAP

• agave • cherries • ice cream • rye • alfalfa • okra

• almond meal • chorizo • kefir • sausages • bean sprouts • olives
• amaranth • coconut water • kidney beans • scallions • black beans • potato
flour • couscous • kombucha • shallots • bok choy • pumpkin
• apples • cream • lima beans • sour cream • broccoli • radish
• apricots • currants • lychee • soybeans • brussels • red peppers
• artichoke • custard • mango • soy milk sprouts • seaweed
• asparagus • dates • milk • spelt flour • butternut • spinach
• avocado • figs • molasses • split peas squash • squash
• baked beans • fructose • muesli cereal • sports drinks • cabbage • sweet potato
• bananas • fruit and • mushrooms • stock cubes • carrots • tomato
• barley herbal teas • nectarines • watermelon • chick peas • turnip
• beer with added • onions • wheat- • chives • zucchini
• black-eyed apple • peaches containing • collard greens
peas • garlic • pears products • corn
• blackberries • gelato • persimmon • whey protein • cucumber
• bran cereals • gnocchi • pesto • wine • eggplant
• butter beans • granola • pistachios • yogurt • fennel
• buttermilk • grapefruit • plums • ginger
• cashews • high-fructose • pomegranate • green beans
• cauliflower corn syrup • prunes • green pepper
• celery • honey • raisins • kale
• cheese • hummus • rum • lettuce

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6 Caffeine
Caffeine is a stimulant found in coffee, soft drinks, tea, and energy drinks. It

reduces fatigue and increases alertness by blocking receptors for adenosine (a

sleep-wake-cycle regulating hormone). For people with caffeine hypersensitivity,

it may cause rapid heartbeat, anxiety, jitters, insomnia, nervousness, or

restlessness.

7 Nuts
Nuts are one of the most common food allergies in the United States, affecting

adults and children alike. Typically caused by tree nuts and peanuts, symptoms

can range from hives to nausea and become as severe as anaphylaxis. Products

with nuts (or ones produced and handled in facilities that house nuts) are often

very clearly marked.

DID YOU KNOW?

Anaphylactic shock is a potentially life-threatening allergic reaction to a food or ingredient.

The onset is characterized by a sudden drop in blood pressure and the narrowing or

blocking of airways.

Epinephrine, often provided in the form of an EpiPen or something similar, is used to treat

anaphylactic shock. Epinephrine causes the blood vessels to quickly constrict, raising

blood pressure as well as relaxing the muscles of the airway and opening the lungs.

Individuals with known allergies will often carry epinephrine with them, and most

restaurants and eateries have them for emergencies as well

OTHER SPECIAL SCENARIOS

Other special nutrition scenarios a nutrition coach may encounter include clients who are

injured or recovering from an injury (and cleared by a medical practitioner), bodybuilders,

people with general inflammation, and athletes.

INJURY
Injury can occur in many ways and may or may not include the presence or loss of blood.

Cuts, bruises, fractures, sprains, muscle trauma, dislocations, and swelling are just a few

potential injuries. Acute injuries occur suddenly, chronic injures build and exist over time, and

overuse injuries are caused by repetition or movement dysfunctions.

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Healing takes time and requires a three-step process in the body. The first phase is known as

hemostasis. This is when blood forms at the sight of the injury and clumps together to form

a clot in the case of bleeding. The clot protects the wound and stops further blood loss. The

clot—made of platelets and a fiber called fibrin—turns into a scab as it dries.

The next phase is inflammation. Once the wound has been closed, the body sends a fresh

supply of nutrient- and oxygen-rich blood to the site to support growth and regeneration.

Chemical signals tell the cells to create collagen, which serves as a type of scaffolding for

the regeneration of new tissue.

During remodeling, the third phase, the body reinforces tissues around the wound area.

Within the first six weeks, the wound heals quickly. At about three months post-injury, the

wound area is about 80 percent as strong as it was prior to the trauma.

In cases of large, severe wounds, the healing process can take up to a couple of years to complete.

Inflammation
The inflammation phase is worth discussing in depth as the term has taken on a negative

connotation in recent years.

As just discussed, one of the natural responses to injury is inflammation. Yet many people

take drastic measures to reduce inflammation during the acute stage of wound repair.

Suppressing this response is not necessary, although controlling it can be beneficial.

Nutrition plays a key role in managing inflammation. As a result of inflammation in the body,

free radicals are produced, and these free radicals cause damage to cells. Flavonoids—
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antioxidants found in cocoa, tea, red wine, fruits, vegetables, and legumes—help manage

inflammation. Eating foods rich in flavonoids is advisable for general health and even more
FREE RADICALS:
Cleaved atoms that can beneficial in acute stages of injury.
damage proteins, DNA, and
cell membranes by stealing
their electrons in a process Other antioxidants—vitamins C, E, and A, beta-carotene, selenium, and zinc—neutralize
called oxidation.
free radicals and help repair the cellular damage they caused. Garlic, turmeric, green tea,

blueberries, apples, citrus fruits, and pineapples all contain valuable antioxidants.

Injuries Involving Immobilization

If an injury is severe enough to warrant immobilization of an extremity, extra care must be

taken. Immobilization of a limb may result in atrophy.

Energy
Under energy restriction (or immobilization), increasing energy intake in the form of consumed

calories can lead to an increase of total and fat mass. However, research has shown that an

injury may increase basal metabolic rate by up to 50 percent after a major surgery.

An individual who typically intakes 2,000 kcal with no exercise may need to intake as many

as 2,400 kcal after minor surgery. As a general rule, energy requirements after an injury are

less than they were during hard training but more than during inactivity.

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Protein and Amino Acids
During healing, protein intake should be maintained or increased (about 2–2.5 grams per

kilogram of bodyweight per day). Research suggests that evenly distributing protein intake

throughout the day is most beneficial for optimal healing. Consuming 20 to 30 grams per

meal or snack is recommended.

Table 18.7 A List of Foods with 20 to 30 Grams of Protein

FOOD AND QUANTITY

3 eggs

1 cup cottage cheese

1 cup Greek yogurt

3–4 ounces of meat, poultry, or fish

2/3 of a 14-ounce cake of firm tofu

1.25 cups of black beans

Some studies show that branched chain amino acids (BCAAs) (whether consumed through

foods or in supplemental forms) may boost protein synthesis and prevent protein breakdown.

Leucine has been found to have the greatest effect on protein synthesis. Foods rich in leucine

include the following:

• Chicken breast • Turkey breast

• Lean beef • Eggs

• Tuna • Peanuts

• Salmon

Other Nutrients and Healing

Scientific evidence suggests that omega-3 fatty acids may help prevent muscle loss and that

creatine may enhance muscle hypertrophy (growth) during healing.

In general, a well-balanced eating pattern will support quick healing in most people. The

variety and consistency of a good diet will provide all the required vitamins and minerals for

cell growth and repair.

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Nutrition Support for Concussion and Brain Injuries

Loss of normal energy production, oxidative stress, and long-term brain inflammation occur

after a concussion or traumatic brain injury. Recent research findings have given insight

into how specific chemicals in the diet can target these negative effects. Initial studies

on animals have found that supplementing with vitamins B3, D, and E improved cognitive

function following repetitive concussive brain injury. It is possible that these vitamins may

also alleviate some of the long-term consequences of traumatic brain injury.

Magnesium and zinc have also been seen as beneficial in brain trauma research.

Supplementing zinc for four weeks following a traumatic brain injury reduced inflammation

and neuronal cell death and decreased depressive symptoms in rats. Finally, omega-3 fatty

acids—specifically DHA and alpha-linolenic acid—seemed to offer neuroprotective qualities

whether taken before or after injury.

BODYBUILDING
Resistance training increases lean muscle mass by causing micro-damage to skeletal

muscle, which is then repaired and strengthened with new, denser muscle tissue. Individual

adaptations to resistance training depend on the training program and intensity as well as

the athlete’s gender and nutritional status. To increase muscle gains via nutrition, many

individuals use one or more of the following methods:

• Protein supplementation

• Protein/nutrient timing

• Bulking phase (calorie surplus)

• Carbohydrate loading

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Protein Supplementation
One of the most common methods individuals use to accelerate lean muscle gains is to

increase protein intake through supplementation (in addition to consumed protein from

meats, legumes, and nuts). Skeletal muscle is made mostly of water and protein, with other

materials making up just about 5 percent of the tissue. Therefore, it seems logical that

increasing protein intake would increase muscle hypertrophy.

Studies show that resistance training alone boosts muscle mass and strength better than

protein supplementation. However, for those who do not consume enough protein daily,

supplementation has been shown to have a positive effect on muscle growth.

Protein Timing
Many experienced athletes and gym-goers commit to timing their meals around training

sessions. However, the science doesn’t support this. The major benefit to timing protein

intake is to spread it out over the course of a day to promote more efficient absorption, as

the body can absorb only 35 to 50 grams at a time.

Some personal trainers suggest that clients consume protein at intervals less than or equal

to one hour before or after the workout. The goal is to give the body the right energy substrates

to repair muscles after resistance training–related damage. Although these studies reported

positive adaptations to muscle strength and hypertrophy, there was no “ideal window of

opportunity” that increased outcomes. The positive effects were from increased protein

intake, not timing.

Bulking Phase
The bulking phase of training is often mistaken for the overconsumption of calories without

increasing activity level or intensity during exercise. If done correctly, there is a delicate

balance between calories and increased resistance or intensity in a training session to

prevent an increase in bodyfat mass in addition to muscle mass. Muscle hypertrophy requires

a surplus of calories, but the type of calories consumed matters. Most athletes and clients

will focus on the addition of complex carbohydrates and protein as an energy source, as they

are used most readily in muscle repair post-exercise.

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Carbohydrate Loading
The practice of carbohydrate loading is typically used by physique competitors and endurance

athletes prior to competition. Typically, carbohydrate consumption is dramatically increased

over the course of 24 to 48 hours pre-competition so that the body stores the excess

glycogen in the muscle tissue and liver to be used as a quick-access energy source.

Carbohydrates bind to water in the body. For every gram of carbohydrate (glycogen), there are

2.7 to 4 grams of water stored with it. In the case of carb loading, when excess glycogen

is stored in muscle cells, then water is also stored. This has the effect of increasing the

fullness of the muscle. In physique competition, this ratio must be closely monitored so that

excess glycogen does not “spill over” to the subcutaneous tissue. When this happens, the

muscles look less hard, which is detrimental in aesthetics competitions. Endurance athletes

are more concerned with loading as much carbohydrate into their bodies as possible to

store glycogen for the event ahead, often following a strict regimen of carbohydrate depletion

followed by carbohydrate supercompensation.

For some, carbohydrate loading can cause gastrointestinal distress and, most visibly, bloating,

edema, and water retention.

WEIGHT LOSS
There are many trending diets able to aid in weight loss. Generally, a weight-loss nutritional

program aims to reduce overall calories consumed daily. The nutrition guidelines chapter

of this text takes a deeper dive into the general healthy-eating guidelines, which promote a

healthy, sustainable weight and prevent chronic disease.

Supplementation
Reducing waist circumference is important, as abdominal fat has been linked to increased

risk of chronic disease and premature death. However, care must be taken when suggesting

supplements to clients for weight loss. Over-the-counter herbs, stimulants, and appetite

suppressants are mostly ineffective and may have additives or additional ingredients and

stimulants that can be considered dangerous. A nutrition coach must fully understand a

client’s allergies and health history prior to making any supplement suggestions.

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Healthy Weight Loss
According to [Link], the US Department of Agriculture’s website, a healthy weight-loss

program should include

• a reasonable, realistic weight-loss goal;

• a reduced-calorie, nutritionally balanced eating plan;

• regular physical activity; and

• a behavior change plan to support new, healthy habits.

ATHLETES
When it comes to athletes, a coach must consider how nutrition will support performance

and recovery.

Performance
During exercise training and competition, an athlete must have enough carbohydrates

and protein to replenish glycogen stores and to build and repair muscle tissue. Fat intake

should be moderate but not reduced, as the body needs essential fatty acids (which are

not produced in the body), and fat plays an important role in many body processes and in

hormone production.

Proper hydration should be the focus before, during, and after activity for all athletes. Sports

beverages with carbohydrates and electrolytes may also help maintain blood glucose concentration,

give fuel for working muscles, and decrease the risk of dehydration or hyponatremia.
HYPONATREMIA:
A condition in which the
With a balanced eating pattern focused on a variety of foods, nutritional supplementation is sodium levels in the blood
are too low and internal
not necessary for most athletes. water regulation becomes
problematic.

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Recovery
If athletes do not have adequate rest from training, or if they do not have a healthful eating

pattern, they can increase their risk of injury. Carbohydrate intake before and during long

bouts of exercise helps keep blood glucose levels stable, reduces stress hormones, and

mitigates the risk of injury. Intakes of up to 60 grams per hour during heavy training can help

reduce natural inflammatory responses.

Eating carbs after a long exercise bout replenishes glycogen stores, readying the muscles for

the next session. Intake should be around 1 to 1.2 grams per kilogram of bodyweight from

whole-food sources like fruits, starchy vegetables, whole grains, and whole-grain, fortified

foods such as bread, cereal, rice, and pasta.

Generally, athletes should include 5 to 12 grams of carbohydrates per kilogram of bodyweight.

Several studies have shown that combining protein and carbohydrates during and after

exercise may:

• decrease fatigue,

• reduce delayed onset muscle soreness, reduce muscle breakdown, and

• optimize muscle damage repair.

The suggested ratio for post-workout food consumption is three to four grams of carbohydrates

for every gram of protein.

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